making the most of your mental health consultation services · tips on high-quality service...

Making the Most of Your Mental

Health Consultation Services

. Amy Hunter, LICSW ah1122@georgetown.edu

National Center on Health

Presentation Objectives

• Define “effective” early childhood mental health consultation (ECMHC)

• Describe core components of effective consultation programs

• Increase awareness of strategies to assess your mental health consultation

• Highlight resources for further guidance

Table Discussion

• What do you think of when you think of early childhood mental health consultation?

• What do parents think?

• What do stakeholders think? (e.g. board, policy council, community agencies/referral sources, etc.)

Definition of Early Childhood

Mental Health Consultation:

“A problem-solving and capacity–building intervention

implemented within a collaborative relationship between a professional consultant with mental health expertise and one or more individuals with other areas of expertise - primarily child care, child development, and families – or individuals with child care responsibilities.”

(Cohen & Kaufmann, 2000)

Defining ECMHC (cont’d)

• Culturally sensitive

• Family focus/ Engaging families

Defining ECMHC (cont’d)

• Promotes social emotional development

• Addresses children’s challenging behavior

• Primarily indirect services

• Impacts child, family, staff, and outcomes

Child- and Family- Centered Consultation

• Child observations

• Parent consultation

• Staff support for individual and group behavior management

• Modeling/coaching

• Link to community

• Training on behavior management

• Modeling and supporting individual child

• Education on a child’s mental health

• Advocacy for family

Programmatic Consultation

for Staff and Programs

• Classroom observation

• Strategies for supportive environments

• Training on behavior management

• Support for reflective practices

• Promote staff wellness

• Address communication issues

• Promote team building

• Training on cultural competence

What ECMHC “Isn’t”

• Formal diagnostic evaluations

• Therapeutic play groups

• Individual therapy

• Family therapy

• Staff therapy

• Family support groups

Summary of Findings: Does it make a

difference?

Child Outcomes

Staff Outcomes

Program Outcomes

Conceptual Model of Effective EMCHC

12

SCENE 1…TAKE 1…

1. Read the Scene on

The front of the card.

2. Discuss your Take on

the scene and decide:

– What type of consultation is indicated?

– What might be the role of the

Mental Health Consultant?

SCENE 1

TAKE 1

IMAGINE AND CREATE…

Think about desirable qualities or traits … What are some important

attributes? Represent these traits on the poster paper figure.

The Effective Consultant:

Qualifications & Characteristics

• Education/Knowledge

– Masters degree in a related field, e.g., social work, psychology

– Core content knowledge

– Respectful

– Trustworthy

– Open-minded/non-judgmental

– Reflective

– Approachable

– Good listener

– Compassionate

– Team player

– Flexible

– Patient

Consultant Knowledge

• Child development • Typical and atypical behavior including:

– Attachment – Separation

• Medical and genetics information • Cultural understanding • Treatment alternatives • Family systems • Early childhood systems • Adult learning principles

Skills and Experience

Specialized Experience

• Separation and loss

• Substance abuse

• Maternal depression

• Abuse and neglect

• Teen motherhood

• Working with fathers

• Early childhood mental health including:

– Aggressive behavior

• Medical concerns including:

– Prematurity and low birth weight

– Failure to thrive

• Developmental delays including:

– Speech and language

– Learning

– Developmental disabilities

Elements of the Consultative Stance

• Mutuality of endeavor

• Avoid position of expert

• Wondering not knowing

• Understanding another subjective experience

• Consider influence

• Hearing and representing all voices

• Centrality of relationships

• Parallel process

• Patience

– Johnston & Brinamen, 2006

Roles and Responsibilities

• Support staff in addressing individual challenges that effect work

• Provide crisis stabilization

• Work with families on resolving behavioral challenges

• Refer when indicated

Getting Off to a Good Start

• Clarify roles and expectations up front

–Written agreements

–Widespread communication

• Integrate into ECE program

–Attend activities/events

– ECE program-level accommodations

Philosophy

• Individuals select two cards

• Chose your best one

• As a group reach consensus on your philosophy

Create a Want-Ad

• Use your philosophy to create a want –ad for the perfect consultant

– Knowledge, experience, skills, duties to perform, attributes

Finding a Consultant

Where Have You Looked?

Delivering High-Quality Services

• Provide an array of services/activities

– Information gathering

– Individualized service plan development

– Plan implementation support

– Provider/family education

– Provider/family emotional support

– Linkages to services beyond consultation

– Staff training and support

Delivering High-Quality Services

• Include both types of consultation

– Child/family-centered consultation:

Focuses on a particular child with challenging behavior and/or the family of that child

– Programmatic consultation:

Focuses on a general program or classroom issue that impacts the mental health of staff, children and/or families

Cohen & Kaufmann, 2000

Classroom-Based

Strategies

Specific Examples

Improve classroom

functionality

•Rearrange furniture to get rid of “run ways”

•De-clutter the classroom to cut down on

overstimulation

Promote social skills •Introduce social stories or “feelings” books that

teach social/emotional concepts and skills

Improve transitions •Introduce “5 minute warnings”

•Use a transitional object to help a child move

from one activity to another

Home-Based Strategies Specific Examples

Support positive behavior

support practices

•Explore setting limits and boundaries

•Post visual reminders around the home

•Create a “time-in” space for child to calm

him/herself

Help parents meet children’s

specific social/emotional

needs

•Create photo books to help children with

attachment issues

•Promote children’s understanding of caregiver

permanence through games like peek-a-boo

Strategy

Examples

Excerpted from What Works? – Table 5, page 73

Tips on High-Quality

Service Delivery

• Strong service initiation process

• Collaboration

• Family involvement

• Cultural and linguistic competence

• Individualization of services/strategies

• Consistency across home & classroom

Tips on High-Quality

Service Delivery (cont’d)

• Utilization of hands-on, practical materials

• Consistency in consultants

• Availability of consultants

• Integration of consultant into program routines and operations

• Facilitation of ECE program requirements and goals

Head Start Performance Standards

1304.24(a)(2)

• “secure the services of mental health professionals on a schedule of sufficient frequency to enable the timely and effective identification of and intervention in family and staff concerns about a child's mental health; and…”

Head Start Performance Standards

1304.24(a)(2)

• “Mental health program services must include a regular schedule of on-site mental health consultation involving the mental health professional, program staff, and parents on how to:…”

Continued 1304.24(a)(2)

• “(i) Design and implement program practices responsive to the identified behavioral and mental health concerns of an individual child or group of children;

• (ii) Promote children's mental wellness by providing group and individual staff and parent education on mental health issues;

• (iii) Assist in providing special help for children with atypical behavior or development; and

• (iv) Utilize other community mental health resources, as needed”

Homework: Assess Your MH

Consultation

• Adopt a Process: Consider

– Survey staff

– Survey families

– Survey your consultant

– Survey community members

Quick Survey Tools

• How is the Mental Health Consultation in the Program? Survey for Families

• How is the Mental Health Consultation in the Program? Survey for Staff

• Assessing Your Program’s Early Childhood Mental Health Consultation: How do you know if your mental health services are effective?

Group Discussion

• Is it Effective?

• Is it Sufficient?

• How do you know?

Additional Considerations in Developing/Refining

ECMHC Models

• Caseloads

• Intensity of services

• Use of best/evidence-based practice(s)

• Local resources/capacity

Key Partners for Effective Consultation

• ECE program administrators

– Strong influence on “readiness” for ECMHC

• Local resources/referral sources

• Consultation “champions”

• Evaluators

Resources

• Center for Effective Mental Health Consultation

http://www.ecmhc.org/

• What Works? study

http://gucchd.georgetown.edu/78358.html

• Mental Health Consultation in Child Care

(K. Johnston & C. Brinamen)

• Mental Health Consultation in Early Childhood

(Donahue, Falk, & Provet)

Wrap-Up- Follow-Up

• E-mails (subject line: ECMH Consultation)

– Within the week: tools and resources (subject: mh consultation)

– MH Consultation Webinar- Jan. 28, 2014

– Spring Follow-up Survey

Wrap-Up Next Steps

• What stood out for you from what you

heard or experienced today?

• What excites you or concerns you about

what you learned?

• Any insights from the session?

• How might you use what you heard

today?

Contact us:

Neal Horen, PhD

horenn@georgetown.edu

Amy Hunter, LICSW ah1122@georgetown.edu